Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A71307 | CA |
NPI | 1336288992 |
---|---|
Provider Name | Dr. Robert Green Watkins IV |
First Address | Marina Del Rey, CA 90292-6621 |
Second Address | Marina Del Rey, CA 90292-6621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 10/06/2014 |